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Öğe Comparison of clinical features of cystic fibrosis patients eligible but not on CFTR modulators to ineligible for CFTR modulators(Wiley, 2024) Buyuksahin, Halime Nayir; Emiralioglu, Nagehan; Yalcin, Ebru; Sen, Velat; Sen, Hadice Selimoglu; Arslan, Huseyin; Baskan, Azer KilicIntroduction: Cystic fibrosis transmembrane conductance regulator (CFTR) modulator drugs target the underlying defect and improve CFTR function. They are a part of standard care in many countries, but not all patients are eligible for these drugs due to age and genotype. Here, we aimed to determine the characteristics of non-eligible patients for CFTR modulators in the CF registry of Turkey (CFRT) to highlight their clinical needs. Methods: This retrospective cohort study included CF patient data from the CFRT in 2021. The decision of eligibility for the CFTR modulator was determined according to the 'Vertex treatment-Finder' on the Vertex (R) website. Demographic and clinical characteristics of patients were compared between eligible (group 1) and ineligible (group 2) groups for CFTR modulators. Results: Among the study population (N = 1527), 873 (57.2%) were in group 1 and 654 (42.8%) were in group 2. There was no statistical difference between groups regarding sex, meconium ileus history, diagnoses via newborn screening, FEV1 z-score, CF-associated complications, organ transplant history, and death. Patients in group 2 had a higher incidence of pancreatic insufficiency (87.7% vs. 83.2%, p = .010), lower median height z-scores (-0.87 vs. -0.55, p < .001), lower median body mass index z-scores (-0.65 vs. -0.50, p < .001), longer days receiving antibiotics due to pulmonary exacerbation (0 [interquartile range, IQR: 0-2] vs. 0 [IQR: 0-7], p = 0.001), and more non-invasive ventilation support (2.6% vs. 0.9%, p = 0.008) than patients in group 1. Conclusion: The ineligible group had worse clinical outcomes than the eligible group. This highlights their need for life-changing drugs to improve clinical outcomes.Öğe An evaluation of treating non-union of femoral neck fractures with valgus angulation osteotomy using sliding hip screws(Acta Medica Belgica, 2019) Ozkul, Emin; Necmioglu, Necdet Serdar; Ziyadanogullari, Mehmet Onur; Alemdar, Celil; Arslan, Huseyin; Uzel, KadirThis study presents the outcomes of patients treated with non-union of femoral neck fractures healed with valgus osteotomy, fixed with a Dynamic Hip Screw (DHS). The study retrospectively evaluated 16 patients who, between 2007 and 2014, developed pseudarthrosis following treatment for a femoral neck fracture and who were treated with DHS-osteosynthesis, after a valgus subtrochanteric osteotomy. Postoperative clinical evaluation of the patients was done? using the Harris Hip Scoring (HHS) system. Union of both the fracture and the osteotomy site was achieved in 17.2 weeks (range: 14-24 weeks) in all patients. The average Pauwels angle decreased from 72o (range 62-80) preoperatively to 26o (range 20-50) postoperatively. All fractures were Pauwels type HI preoperatively and 4 type II and 12 type I postoperatively. The average HHS increased from 26 (range 18-34) preoperatively to 85 (range 68-94) postoperatively. Of the patients who were followed up for a mean duration of 3.1 years (range: 1-5 years), four had 1-cm shortening. No patient developed postoperative AVN of the femoral head. For patients with non-union after femoral neck fracture, DHS-osteosynthesis after valgus osteotomy is a method with a shorter learning curve, which can be successfully performed.Öğe Gorham-Stout's disease in the metatarsus: a case report(Turkish Assoc Orthopaedics Traumatology, 2014) Gem, Mehmet; Ozkul, Emin; Arslan, HuseyinGorham-Stout disease (GSD) is a rare disease occurring in the bone tissue and is characterized by spontaneous, progressive resorption. The etiology and treatment of the disease remains unclear. This article presents a 53-year-old male patient diagnosed with GSD in the 3rd and 4th metatarsal of his right foot.Öğe How Safe is Titanium Elastic Nail Application in the SurgicalTreatment of Tibia Fractures in Children ?(Acta Medica Belgica, 2014) Ozkul, Emin; Gem, Mehmet; Arslan, Huseyin; Alemdar, Celil; Bogatekin, Ferit; Senturk, IhsanTibia fractures in children are generally treated successfully by conservative means. The aim of this study was to evaluate the efficacy and safety of fixation using Titanium elastic nails (TEN) in pediatric tibia fractures in which conservative measures failed or were deemed inapplicable. In this study, 30 patients who had tibia fractures and were fixated with TEN between 2007 and 2011 were analyzed retrospectively. The procedure was performed after poly-trauma in six patients, open fracture in seven, reduction loss in twelve, and unsuccessful closed reduction in five patients. The number of girls and boys was 3 and 27, respectively, with a mean age of 9.8 years. The evaluation criteria of Flynn et al. were used in the analysis of the results. The mean follow-up period was 18 months. The mean period of union was 8 weeks and 14 weeks in closed and open fractures, respectively. Epiphyseal damage, rotational deformity, need for reintervention, deep infection, implant failure, or recurrent fracture was not observed in any case. According to the Flynn evaluation system, 23 cases were evaluated as excellent, and 7 as good. Fixation with TEN is an easy, effective, and safe method that can be used in tibia fractures that are open, irreducible, or with loss of reduction and in cases with accompanying trauma, such as floating knee.Öğe Is varus osteotomy necessary in one-stage treatment of developmental dislocation of the hip in older children?(British Editorial Soc Bone Joint Surgery, 2007) Arslan, Huseyin; Kapukaya, Ahmet; Bekler, H. Ibrahim; Necmioglu, SerdarPurpose Innominate osteotomy, varisation-derotation osteotomy, and shortening osteotomy are the most common surgical procedures used to achieve pelvifemoral realignment in the treatment of children over three years of age with developmental hip dislocation. It is well known that varus osteotomy can improve the acetabular index but it does have some disadvantages. The aim of this study was to discuss the results obtained with patients treated only with Salter osteotomy, derotation osteotomy, and shortening, without varus osteotomy, and to evaluate the need for varisation on the basis of these results. Methods Between 1996 and 2001, twenty-four hips, sixteen unilateral and four bilateral, of a total of twenty patients treated with this method and available for final controls were evaluated. The study included sixteen female and four male patients with a mean age of 4 years 2 months (ranging between 2 years 10 months and 8 years). The mean follow-up period was determined as 6.57 years (range 5-10 years). McKay's clinical criteria, Sever's radiological criteria, and the evaluation system modified by Trevor et al. were used for evaluation of the results. Results Based on McKay's clinical criteria, eighteen hips (75%) were classified as type I, four hips (16%) as type II, and two hips (9%) as type III. According to Sever's radiological criteria, thirteen hips (54%) were graded as grade I, nine hips (37.5%) as grade II, and two (8.5%) as grade III. According to the modified evaluation system of Trevor et al. the results were categorized as excellent in thirteen hips, good in nine hips, and moderate in two hips. Pre-operative mean acetabular index was measured as 37.3 degrees (28 degrees-50 degrees) and early post-operative mean acetabular index as 26 degrees (18 degrees-38 degrees). In the final radiological examination the mean acetabular index was measured as 18.3 degrees and the mean CE angle as 30.1 degrees (15 degrees-38 degrees). Avascular necrosis affecting the results developed in five hips. Conclusion It is concluded that in older children with developmental dislocation of the hip (DDH) treated with one-stage combined surgical intervention, adequately stable concentric reduction can be achieved without varisation and that varus osteotomy is not always necessary.Öğe The Level of IL-1? In Orthodontically Treated Osteopototlc Rats(Aves Press Ltd, 2008) Gunduz-Arslan, Seher; Kaya, Filiz Acun; Arslan, Huseyin; Kaya, Can Ayhan; Hamamci, OrhanThis study aims to evaluate the levels of IL-1 beta, in samples taken from the gingival crevicular fluid (GFU) of osteoporotic rats during orthodontic treatment. 33 adult female Spraque-Dawley rats were divided into 2 groups. (15 control and 18 study group) In study group bilateral ovariectomy was carried out to create osteoporotic rats. And also in control group sham operation was carried out. Two months following the operation, an open coil spring applying 10g force, was placed actively between the upper incisors of the rats Shortly after activation, samples were taken from the gingival crevicular fluid from the vestibular surface of appliance fixed teeth on the 3rd,7th and 10th days. Samples were analyzed biochemically. The statistical analysis of data acquired from the samples was carried out by using ANOVA test. The evaluation of the changes between the groups was carried out by using Mann Whitney U test. It was observed that the level of IL-1 beta were high on the 3rd and 7th in both groups. In the comparison of control and study groups there were significant differences between the working days.Öğe Minimally Invasive Plate Osteosynthesis in Open Pediatric Tibial Fractures(Lippincott Williams & Wilkins, 2016) Ozkul, Emin; Gem, Mehmet; Arslan, Huseyin; Alemdar, Celil; Azboy, Ibrahim; Arslan, Seher G.Objectives: The aim of this study is to investigate the effectiveness and reliability of limited-contact locking plates in minimally invasive percutaneous osteosynthesis (MIPO) of the lateral tibia. Design: A retrospective study. Patients and Methods: The retrospective study included 14 patients who were operatively treated with an MIPO technique due to open tibial fractures between 2006 and 2012. The patients were 11 males and 3 females with a mean age of 13.2 (range, 9 to 16) years. The patients were followed up for a mean period of 2.4 (range, 1 to 5) years. The mechanism of the injuries included a motor vehicle accident (n=11), a shotgun injury (n=2), and a fall from height (n=1). According to the Gustilo-Anderson classification, 10 patients had type I (72%), 2 had type II (14%), and 2 had type III (14%) open fractures. Results: The mean time to radiologic union was 18 (range, 11 to 32) weeks. No infection was detected that would require implant removal. No complications such as early epiphyseal closure, angulation, or limb-length inequality were observed. Conclusions: Limited-contact locking plates in MIPO of the lateral tibia is an effective alternative method in the treatment of open pediatric tibial fractures.Öğe NATIONAL REGISTRY SYSTEM FOR HOME MECHANICAL VENTILATION SUPPORT IN CHILDREN: FIRST DATA FROM TURKEY(European Respiratory Soc Journals Ltd, 2024) Cakar, Neval Metin; Selcuk, Merve; Baskan, Azer Kilic; Unal, Fusun; Unal, Gokcen; Sunman, Birce; Arslan, HuseyinÖğe A Newly Designed Intramedullary Nail for the Treatment of Diaphyseal Forearm Fractures in Adults(Medknow Publications & Media Pvt Ltd, 2017) Azboy, Ibrahim; Demirtas, Abdullah; Alemdar, Celil; Gem, Mehmet; Uzel, Kadir; Arslan, HuseyinBackground: The treatment of diaphyseal forearm fractures using open reduction and plate fixation is generally accepted as the best choice in many studies. However, periosteal stripping, haematoma evacuation may result in delayed union, nonunion and infection. Refracture after plate removal is another concern. To overcome these problems intramedullary nails (IM) with different designs have been used with various outcomes. However previous IM nails have some shortcomings such is rotational instability and interlocking difficulties. We evaluated the results of newly designed IM nail in the treatment of diaphyseal forearm fractures in adults. Materials and Methods: 32 patients who had been treated with the interlocking IM nail for forearm fractures between 2011 and 2014 were included in this study. There were 23 males and 9 females with mean age of 36 years (range 18-68 years). 22 patients (68.8%) had both bone fractures. Nine patients (28.1%) had open fractures. The remaining ten patients (31.2%) had radius or ulna fractures. Grace and Eversmann rating system was used to assess functional evaluation. Patient reported outcomes were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire scores. Results: Union was achieved in all patients. The mean followup was 17 months (range 13 - 28 months). According to the Grace-Eversmann criteria, 27 patients (87.5%) had excellent or good results. The mean DASH score was 14 (range 5-36). Overall complication rate was 12.5%. Superficial infection was encountered in two patients. One patient had delayed union, however fracture healed without any additional surgical procedure. One patient who had open grade 3A, comminuted proximal third radius fracture developed radioulnar synostosis. Conclusions: The new design IM interlocking forearm nail provides satisfactory functional and radiological outcomes in the treatment of adult diaphyseal forearm fractures.Öğe One-stage bilateral open reduction using the anterior iliofemoral approach in developmental dysplasia of the hip(Acta Medica Belgica, 2014) Gem, Mehmet; Arslan, Huseyin; Ozkul, Emin; Alemdar, Celil; Azboy, Ibrahim; Demrtas, AbdullahThe aim of this study was to investigate the safety of one-stage bilateral open reduction using the anterior approach in the treatment of patients with bilateral Tonnis Type III and IV Developmental Dysplasia of the Hip (DDH). Forty-six patients were retrospectively evaluated. Thirty-eight were female, eight were male. The mean age was 16.63 (11-29) months. The mean follow-up period was 27.18 (12-65) months. The mean hospitalization period after surgery was 1.91 (1-5) days. The mean pre-operative hematocrit level was 35.14% (28.1-44.1) and the mean pre-operative hemoglobin level was 11.75 g/dl (9.3-13.6). The mean post-operative hematocrit level was 32.54% (26.7-40.4) and the mean post-operative hemoglobin level was 10.80 g/dl (8.78-12.3). None of the patients required blood transfusion. The mean anesthesia duration was 133.30 (95-180) minutes, and the mean operation duration was 107.58 (70-145) minutes. According to the modified scoring system by Trevor et al, excellent results were obtained in 66 hips of 46 patients (71.8%), and good results were obtained in 26 hips (28.2%). Twenty two hips (23.91%), which developed acetabular dysplasia in the follow-up period required a secondary acetabular intervention. According to the Kalamchi and MacEwen classification, Type I avascular necrosis developed in ten hips, Type II in one hip, and Type IV in two hips. One-stage bilateral open reduction using the anterior iliofemoral approach in Tonnis Type III and IV DDH at walking age is a safe, time-saving treatment method that shortens the hospitalization and immobilization periods.Öğe Outcome in unilateral or bilateral DDH treated with one-stage combined procedure(Lippincott Williams & Wilkins, 2008) Subasi, Mehmet; Arslan, Huseyin; Cebesoy, Oguz; Buyukbebeci, Orhan; Kapukaya, AhmetThe surgical treatment of patients with neglected developmental dysplasia of the hip (DDH) has been the subject of controversy. We asked if age affected outcome in patients with neglected DDH with unilateral or bilateral dislocation who underwent one-stage combined procedures. We retrospectively reviewed the results of 40 patients (51 hips) treated with a one-stage combined procedure consisting of open reduction, pelvic osteotomy, and femoral shortening. The average age at the time of surgery was 5.4 years for Group I (bilateral dislocation, 22 hips) and 6.7 years for Group II (unilateral dislocation, 29 hips). Mean followup was 5.4 years for Group I and 6.7 years for Group II. According to the modified score system of Trevor et al, 13 hips rated excellent, three were good, and six were fair in Group I; the ratings were 14, nine, and six hips respectively in Group II. Four patients had a limb-length discrepancy of approximately 1.5 cm in Group I. Twelve hips in Group I and 18 hips in Group II had osteonecrosis of varying severity. Our data suggest the outcomes of the children who were 5.5 years or younger in Group I and 8 years or younger in Group II were better.Öğe Outcome of open comminuted tibial plateau fractures treated using an external fixator(Elsevier Science Bv, 2007) Subasi, Mehmet; Kapukaya, Ahmet; Arslan, Huseyin; Ozkul, Emin; Cebesoy, OguzBackground. The purpose of this study was to evaluate the outcome of open severe comminuted tibial plateau fractures treated with minimal internal fixation and circular external fixation frames. Methods. Fifteen open comminuted tibial plateau fractures were involved in this retrospective study. In eight knees, the fracture was reduced through an extended open traumatic wound. In seven patients, another limited incision over the major fracture line or area of comminution was performed to assist in reducing the articular reduction. Simultaneous bone grafting, soft tissue reconstruction, and stabilization of the fracture using a circular external fixator were carried out. Results. The patients were followed for an average of 32 months (range 24-54 months). The average time to union of the fractures and frame removal was 22.8 weeks (range 16-44 weeks). The quality of the reduction of the joint surface was rated as anatomical in four patients, good in five patients, fair in three patients, and poor in three patients. Four patients experienced loss of articular reduction. The Knee Society Clinical Rating scores indicated that three knees were excellent, seven were good, one was fair, and four were poor. Complications included one case of septic arthritis, one of osteomyelitis, one of malunion, and four with loss of reduction. Conclusions. This technique provided acceptable results for open severe comminuted fractures of the tibial plateau without comminuted posterior wall fractures. The most significant disadvantage of the technique is insufficient anatomical reduction and loss of reduction in comminuted posterior wall fractures in the coronal plane. This technique should be combined with a minimally invasive internal fixation method to prevent loss of reduction in open severe comminuted and irreducible tibial plateau fractures.Öğe Post therapeutic lower extremity rotational profiles in children with DDH(British Editorial Soc Bone Joint Surgery, 2008) Arslan, Huseyin; Ersoz, Huseyin; Kisin, Bulent; Kapukaya, Ahmet; Necmioglu, SerdarPurpose The purpose of this study was to investigate post-therapeutic lower extremity rotational profiles in children with developmental dislocation of the hip (DDH), the differences between these values and those of normal children, and the relationship between these differences and clinical and radiological results. Methods In 82 lower extremities of 64 patients, the footprogression angle was measured clinically and the transmalleolar axis angle photographically, and hip rotations and thigh-foot angle were measured both clinically and photographically. The data obtained were compared with Staheli's data for normal children. In addition, clinical and radiographic data were compared within subgroups and with Staheli's data. Student's t-test and one-way ANOVA were used for statistical evaluation. Results The medial rotation of the hip, the average clinical value was 44.668, and the photographic value was 42.288. Lateral rotation of the hip, the average clinical value was 38.018, and the average photographic value was 37.298. Thigh-foot angle, his angle was clinically 8.238 and photographically 9.688. Angle of the transmalleolar axis, the photographic average was 21.598. Foot-progression angle, the clinical average was 10.708. It was determined that the lower extremity rotational profiles of children with DDH treated after walking did not differ from those of normal children, but that the internal and external hip rotations of McKay type III and IV patients were below those of normal children and of McKay type I and II patients. Conclusion Lower extremity rotational profiles in children with DDH who received appropriate treatment were the same as those for normal children.Öğe Primary xanthofibroma in the calcaneus: a case report(Turkish Assoc Orthopaedics Traumatology, 2011) Kapukaya, Ahmet; Arslan, Huseyin; Ozkul, Emin; Mizrak, BulentXanthoma or xanthofibroma is a lesion, characterized by foamy histiocytes (xanthoma cell) and is mostly seen in soft tissue. Xanthoma may also occur in in the skeletal system of patients with an abnormal lipid metabolism. We present a 22-year-old man with primary xanthofibroma in the calcaneus, who was treated by curettage and grafting of the lesion.Öğe Segmental Bone Loss in Pediatric Lower Extremity Fractures: Indications and Results of Bone Transport(Lippincott Williams & Wilkins, 2015) Arslan, Huseyin; Ozkul, Emin; Gem, Mehmet; Alemdar, Celil; Sahin, Ilhami; Kisin, BulentBackground: In this study, we evaluated the results of external bone transport, which was applied to 11 patients with traumatic bone loss who had not completed their bone development. Methods: The average age of the 9 male and 2 female patients was 10.6 (range, 8 to 16) years. Eight of the defects were located in the tibia, whereas the other 3 were in the femur. The average defect was 5.4 (range, 4.5 to 8.5) cm. External bone transport was applied in the early period in 7 patients, whereas in 4 patients it was performed due to nonunion. Bifocal osteosynthesis and single osteotomy were performed in 2 patients with type B2 nonunion. Compression to the nonunion region and lengthening in the osteotomy region were applied. In 2 patients with type B1 nonunion, and the other 9 patients who had external bone transport, the gap was eliminated by bifocal osteosynthesis, single osteotomy, and bone transport to the osteotomy line. Results: The mean follow-up period was 21 (range, 13 to 48) months. Complete union was achieved in all patients without any bone operation or graft application. No refracture was observed after the removal of the external fixator, and the average hospitalization time was 16 (range, 7 to 65) days. The average external fixation time was 4.2 (range, 3.5 to 5.5) months, and the mean external fixator index was 0.8 months (23 d/cm). The mean bone healing time was 5.1 (range, 4.6 to 6) months. Conclusions: To initially consider the open fractures with true or in situ bone loss in children as anticipated nonunion, and determine the treatment strategies regarding this fact, may prevent nonunion and shorten the healing period. Bone transport in the treatment of traumatic bone defects in children is an easy biological procedure, with lower complications but higher success ratios.Öğe Should routine pelvic osteotomy be added to the treatment of DDH after 18 months ?(Acta Medica Belgica, 2014) Arslan, Huseyin; Sucu, Ekim; Ozkul, Emin; Gem, Mehmet; Kisin, BulentThe treatment of developmental dysplasia of the hip (DDH) between ages 1-3 years is controversial. Particularly controversial is the age after which pelvic osteotomy should be added to the treatment. In the present study, the outcomes of DDH patients aged 1-3 years treated with anterior open reduction alone were evaluated, and the relationship between inadequate acetabular development, the need for secondary pelvic osteotomy, and age was investigated. A total of 53 patients (70 hips) who had begun walking, who had undergone open reduction through an anterolateral approach, who had a follow-up period of at least 2 years, and who had Tonnis grade III and IV hip dysplasia were included in the study. They were grouped according to treatment age (pre-18 months : Group I; post-18 months : Group II), and the two groups were compared with regard to radiological and functional outcomes and the need for a secondary acetabular procedure. In Group I there were 29 hips (mean age : 16.09 months) and in group II there were 41 hips (mean age : 23.1 months), and the mean follow-up period was 48.9 months. According to the modified Trevor score, in Group I outcomes were excellent in 23 hips (79.3%) and good in 6 hips (20.7%), while in group II outcomes were excellent in 30 hips (73.2%), good in 10 hips (24.4%), and fair in 1 hip (2.1%). The difference between outcomes was not significant (P > 0.05). Inadequate acetabular development was determined in 11 hips in group I (37.9%) and in 16 hips in group II (39%). There was no difference between groups in terms of inadequate acetabular development or the need for acetabular prodecures (p > 0.05). No significant difference was determined between DDH patients treated before 18 months and those treated after 18 months with regard to unsatisfactory acetabular development or the need for secondary acetabular procedures. According to these results, reduction prior to 18 months does not always achieve satisfactory acetabular development, and secondary acetabular procedures are not always necessary in patients who undergo reduction after 18 months. In the treatment of DDH, the decision to perform primary pelvic osteotomy in addition to open reduction should be made not according to whether the patient is older or younger than 18 months, but according to stability, and all patients should be followed closely with regard to the need for pelvic osteotomy.Öğe Surgical treatment outcome for open supracondylar humerus fractures in children(Acta Medica Belgica, 2013) Ozkul, Emin; Gem, Mehmet; Arslan, Huseyin; Alemdar, Celil; Demirtas, Abdullah; Kisin, BulentAlthough numerous studies have been conducted on supracondylar humerus fractures in children, there is only a limited number of studies regarding the outcome of open fractures. In this study, the early and late outcome of open supracondylar humerus fractures in children were evaluated. The outcome in 26 children (19 males, 7 females) treated for open supracondylar humerus fractures was evaluated retrospectively. The mean age was 7.3 years (range : 4 to 14) and the mean follow-up period was 43 years (range : 2-8). According to the Gustilo-Anderson classification, 18 patients (69%) had type 1 and 8 patients (31%) type 2 open fractures. Nine patients (34%) presented with a nerve injury. Distal pulses could not be detected in four patients (15%). Functional outcomes were evaluated according to the scoring criteria by Flynn et al. Pin tract infection developed in one patient (3%). Artery repair via an anterior approach was performed in one patient. In nine patients with neurological symptoms, nerve functions were restored within three to six months. The mean union time was six weeks (5-8 weeks). According to the scoring criteria by Flynn et al, an excellent outcome was achieved in 23 patients, and a successful outcome in 3 patients. According to these findings, although vascular and nerve injuries frequently accompany open supracondylar humerus fractures in children, the late radiological and functional outcome was as good as in closed fractures.Öğe Vascular injury following supracondylar humerus fractures in children(Turkish Assoc Trauma Emergency Surgery, 2016) Ozkul, Emin; Gem, Mehmet; Alemdar, Celil; Arslan, Huseyin; Azboy, Ibrahim; Celik, VelatBACKGROUND: The aim of this study was to evaluate the outcomes of the children with absent distal pulses following supracondylar humerus fractures. METHODS: Forty-two pulseless hand patients who were treated due to supracondylar humerus fractures were evaluated retrospectively. The evaluation included symptoms presented at preoperative and postoperative neurological examinations, mechanism of injury, time from injury to presentation, time from injury to surgery, length of hospital stay, and postoperative complications. RESULTS: In 27 patients, radial pulse was palpated following reduction. A stream was identified in ten patients with Doppler, and no stream was identified in two patients. These two patients had no ischemia and they presented with a stream on Doppler one day after the surgery. Immediate vascular exploration was applied in three patients (7%) who retained ischemia after the reduction and was unable to present a stream on Doppler. One patient underwent primary suture, and the other two were managed with saphenous vein graft and primary repair. DISCUSSION: It is vital to re-evaluate patients presenting with a pulseless hand following supracondylar humerus fracture; the ones with no ischemia or ischemic sign should be closely followed, and the ones retaining ischemic signs should be managed with primary vascular repair.
